Physical examination
of the chest
郑翠霞
Significance
? General condition comprehension
? Confirm history information
? Specific sign collection for the diagnosis of
certain disease & infers certain accessory
examines
? Grossly preclude some certain disorders
? Contribute a relation between the physician
and the patient
Mention of Conduction
?Exposure / warmth / lighting /easy air
? Inspection,palpation,percussion,auscultation
?Anterior-lateral-posterior Top- base
?Comparison,top to base/ left to right
Bone landmark
? suprasternal notch(胸骨上切迹 )
? clavicle（锁骨）
? Manubrium sterni(胸骨柄 )
? Sternal angle(胸骨角 ) Louis angle
? suprabdominal angle(腹上角 )
? xiphoid process(剑突 )
? Ribs & interspaces
? scapula(肩胛骨 )
? spinous process(棘突 )
? costolspinal angle(肋脊角 )
Vertical lines
? Anteriol middle line(前正中线）
? Mid-clavicular lines（锁骨中线）
? Spinal line（后正中线）
? axillary lines (anteriol,middle,posteriol)
（腋前、中、后线）
? Scapular lines（肩胛线）
Natural fossa & anatomic region
? Axillary fossa
? Supraclavicular fossa
? Suprasternal fossa
? Infraclavicular fossa
? Suprascapular region
? Infrascapular region
? Interscapular region
The boundary of lung & pleura
? Lung apex
? Upper boundary of the lung
? Outer boundary
? Inner boundary
? Lower boundary,
Midclavicular line 6th interspace
Midaxillary line 8th interspace
Inferior line 10th interspace
Chest wall
? Vein, Blood flow direction
? Subcutaneius emphysema(皮下气肿 )
? Tenderness
? Interspace
Chest framwork
?Normal A-P/T diameter,1/1.5
?Flat chest
?Barrel chest
?Rachitic chest Rachitic rosary（肋骨串珠）
? Funnel chest（漏斗胸）
?Unilateral deformation
?Local bulge of chest wall
?Thoracic deformity caused by deformed spine
Inspection
? Breathing movement,
? Diaphragmatic vs costal respiration
? Respiratory rate,
? --- Tachypnea
? ---Bradypnea
? ---Change of the breath depths
Inspection(2)
? Rhythm of the breath
? ---Tidal brathing
? ---Ataxic breathing
? ---Inhibitory breathing
? ---Sighing respiration
Normal
Bradypnea
Tachypnea
Kusmols breath
Sighing respiration
Tidal breath
Ataxic breath
Inhibitory breath
Palpation
? Vocal fremitus(触觉语颤 )
? Thoracic expansion
? Pleural friction fremitus(胸膜摩擦感 )
? Confirme the inspection
Percussion
Method,mediate percussion
(Technics)
immediate percussion
plexemeter/ plexor finger
Percussion notes and their characteristics
R e l a t i v e
i n t e n s i t y
R e l a t i v
e p i t c h
R e l a t i v e
d u r a t i o n
e x a m p l e
l o c a t i o n
F l a t n e s s s o f t h i g h s h o r t T h i g h
D u l l n e s s M e d i u m m e d i u m M e d i u m L i v e r
R e s o n a n c e L o u d L o w L o n g N o r m a l
l u n g
H y p e r r e s o n
a n c e
V e r y l o u d L o w e r L o n g e r N o n e
n o r m a l l y
t y m p a n y l o u d H i g h L o n g G a s t r i c a i r
b u b b l e o f
p u f f e d - o u t
c h e e k
?Influencing factors for percussion
Lung boundaries being percussed
Kronig isthmus
the movement range of the lower
pulomonary boundary
Midclavicular line 6th interspace
Midaxillary line 8th interspace
Inferior line 10th interspace
of the chest
郑翠霞
Significance
? General condition comprehension
? Confirm history information
? Specific sign collection for the diagnosis of
certain disease & infers certain accessory
examines
? Grossly preclude some certain disorders
? Contribute a relation between the physician
and the patient
Mention of Conduction
?Exposure / warmth / lighting /easy air
? Inspection,palpation,percussion,auscultation
?Anterior-lateral-posterior Top- base
?Comparison,top to base/ left to right
Bone landmark
? suprasternal notch(胸骨上切迹 )
? clavicle（锁骨）
? Manubrium sterni(胸骨柄 )
? Sternal angle(胸骨角 ) Louis angle
? suprabdominal angle(腹上角 )
? xiphoid process(剑突 )
? Ribs & interspaces
? scapula(肩胛骨 )
? spinous process(棘突 )
? costolspinal angle(肋脊角 )
Vertical lines
? Anteriol middle line(前正中线）
? Mid-clavicular lines（锁骨中线）
? Spinal line（后正中线）
? axillary lines (anteriol,middle,posteriol)
（腋前、中、后线）
? Scapular lines（肩胛线）
Natural fossa & anatomic region
? Axillary fossa
? Supraclavicular fossa
? Suprasternal fossa
? Infraclavicular fossa
? Suprascapular region
? Infrascapular region
? Interscapular region
The boundary of lung & pleura
? Lung apex
? Upper boundary of the lung
? Outer boundary
? Inner boundary
? Lower boundary,
Midclavicular line 6th interspace
Midaxillary line 8th interspace
Inferior line 10th interspace
Chest wall
? Vein, Blood flow direction
? Subcutaneius emphysema(皮下气肿 )
? Tenderness
? Interspace
Chest framwork
?Normal A-P/T diameter,1/1.5
?Flat chest
?Barrel chest
?Rachitic chest Rachitic rosary（肋骨串珠）
? Funnel chest（漏斗胸）
?Unilateral deformation
?Local bulge of chest wall
?Thoracic deformity caused by deformed spine
Inspection
? Breathing movement,
? Diaphragmatic vs costal respiration
? Respiratory rate,
? --- Tachypnea
? ---Bradypnea
? ---Change of the breath depths
Inspection(2)
? Rhythm of the breath
? ---Tidal brathing
? ---Ataxic breathing
? ---Inhibitory breathing
? ---Sighing respiration
Normal
Bradypnea
Tachypnea
Kusmols breath
Sighing respiration
Tidal breath
Ataxic breath
Inhibitory breath
Palpation
? Vocal fremitus(触觉语颤 )
? Thoracic expansion
? Pleural friction fremitus(胸膜摩擦感 )
? Confirme the inspection
Percussion
Method,mediate percussion
(Technics)
immediate percussion
plexemeter/ plexor finger
Percussion notes and their characteristics
R e l a t i v e
i n t e n s i t y
R e l a t i v
e p i t c h
R e l a t i v e
d u r a t i o n
e x a m p l e
l o c a t i o n
F l a t n e s s s o f t h i g h s h o r t T h i g h
D u l l n e s s M e d i u m m e d i u m M e d i u m L i v e r
R e s o n a n c e L o u d L o w L o n g N o r m a l
l u n g
H y p e r r e s o n
a n c e
V e r y l o u d L o w e r L o n g e r N o n e
n o r m a l l y
t y m p a n y l o u d H i g h L o n g G a s t r i c a i r
b u b b l e o f
p u f f e d - o u t
c h e e k
?Influencing factors for percussion
Lung boundaries being percussed
Kronig isthmus
the movement range of the lower
pulomonary boundary
Midclavicular line 6th interspace
Midaxillary line 8th interspace
Inferior line 10th interspace
